Surgical treatment of ischemic mitral regurgitation by repair and replacement
The combination of mitral regurgitation and coronary artery disease presents a most significant challenge to the cardiac surgeon. Over the years this entity has the highest operative risk of any of the commonplace, acquired cardiac lesions treated surgically. Previous results from our clinic and others have documented relatively high operative mortality rates due to the urgency of the presentation, the extremely precarious myocardial function, severe triple-vessel coronary disease and prolonged operative insult, or a combination of all four of these factors [3,7, 8,10,14, 16, 18]. Superimposed on a scenario of congestive failure due to severe valvular regurgitation is an often compromised ventricle derived from factors normally related to mitral regurgitation. In addition, the lack of deliverance of appropriate blood supply to these areas may be further complicated by a previous myocardial infarction and scarring. Many reported series have indicated an operative risk of 12–20% using valve replacement alone.
KeywordsCatheter Ischemia Cage Aspirin Endocarditis
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- 2.Arcidi JM, Hebeler RF, Craver JM, Jones EL, Hatcher CR, Guyton RA (1988) Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone. J Thorac Cardiovasc 95:951–959Google Scholar
- 4.Cohn LH, Allred EN, Cohn LA, Austin JC, Sabik J, DiSesa VJ, Shemin RJ, Collins JJ (1985) Early and late risk of mitral valve replacement. J Thorac Cardiovasc 90:872–881Google Scholar
- 5.Cohn LH, Allred EN, Cohn LA, DiSesa VJ, Shemin RJ, Collins JJ Jr (1985) Long term results of open mitral valve reconstruction for mitral stenosis. Am J Cardiol 55:371–374Google Scholar
- 8.Czer LS, Gray RJ, DeRobertis MA, Bateman TM, Steward ME, Chaux A, Matloff JM (1984) Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation [Suppl I] 70:1–198Google Scholar
- 9.Davis TE, Uden PE, Straus HS (1983) The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 68(III):71–82Google Scholar
- 17.McGoon DC (1960) Repair of mitral insufficiency due to ruptured chordae tendinae. JTCVS 39:357–361Google Scholar